The Founders' health-care mandate

By
Ezra Klein

In July of 1798, Congress passed – and President John Adams signed - “An Act for the Relief of Sick and Disabled Seamen.” The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insurance.

Keep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitution.

If you read Rick Ungar's excellent explanation of the bill, you'll see it was a bit different than the individual mandate: It was a payroll tax that all sailors on private merchant ships had to pay, and in return, they were basically given access to a small public health-care system. But it was, in essence, a regulation against a form of inactivity: You were not allowed to not do something, in this case, pay for sailor's health insurance.

And by the way, if conservatives really do prefer a system of payroll taxes that purchase you public insurance to the private system envisioned in the Affordable Care Act, I'm sure there are a lot of liberals who would vote for a bill that repealed the Affordable Care Act and replaced it with Medicare-for-all.

somehow I don't think the founders expected or accounted for $100+ billion per year in fraud waste and abuse in the marine hospital service. Lots of things work well in small doses but don't work well when expanded over a much larger and diverse population and over time.

"somehow I don't think the founders expected or accounted for $100+ billion per year in fraud waste and abuse in the marine hospital service. Lots of things work well in small doses but don't work well when expanded over a much larger and diverse population and over time."

Of course, that is shifting the goal lines from, say, against original intent to a purely instrumental reasoning which would require its own form of argument and evidence.

"Keep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitution."

There were meddlers and looters right from the start (and before the start). Freedom permits many things, not all of them right and proper. The Adams administration was particularly prone to exceeding the bounds of the charter.

And Klein's hand waving about "they did it, too" is the argument of a child.

It's important to note that a key principle of originalism is that you look to what the framers of the Constitution (or a particular Amendment) did when those framers passed legislation in Congress. The idea is that the framers would not have drafted legislation in Congress that they thought violated the Constitution or Amendment they just drafted. So the fact that many of the framers of the interstate commerce clause would also draft this legislation should -- should -- be evidence for originalists of the constitutionality of the mandate. The question is whether originalists can concoct some distinction, from an interstate commerce perspective, between imposing a mandate on sailors as opposed to imposing a mandate on generic citizens.

Ezra,
The similarities don't exist! Adams didn't mandate that fees/taxes be paid as a condition of citizenship, it was conditional on your employment. If one objected you could quit and go work someplace else. It is much more akin to needing insurance in order to operate a car; don't like it get rid of the car and take the bus. Voila, no mandate. Stupid analogy!!

--*I think you, Ezra, just turned all the originalist and "let's read the Constitution in the House" lovers into "the Founding Fathers didn't understand everything about freedom" naysayers.*--

To pretend that the founders were in agreement on every small or big thing is fatuous. There was much disagreement on the reach and scope of government, which is one reason the Constitution is as nebulous as it is. It's also the reason that the Declaration of Independence was a truly revolutionary document, while the Constitution isn't.

And we can see today how Adams' little twenty cent per individual per month tax (and associated government "investment" in hospitals, etc) was ill advised. There is a straight line from that enactment to the health care "crisis" threatening our fiscal solvency today, every step of the way some meddler/looter pointing back and saying, "They did it, too."

I also note that Klein, coming into this issue after it's been kicked around elsewhere for a couple days, is careful to condescend that the act was a "tax", which differentiates it from the modern mandate to buy health insurance, though he quickly throws that muddle in, too, despite the analogy's obvious failing, just because the propaganda is strong in him.

"And we can see today how Adams' little twenty cent per individual per month tax (and associated government "investment" in hospitals, etc) was ill advised."

Actually I'm a little too slow to see how “An Act for the Relief of Sick and Disabled Seamen" caused the health care crisis today. Maybe you could expand on that a little.

And the Act wasn't just a tax. The funding was used to... build hospitals and provide Gummint health care to all who paid the tax. The Act lives on, albeit in a much different form, today in the Public Health Service and the Surgeon General. You know, those terrible people who try to get people to stop smoking and rush in to stop epidemics. Socialists!

Ezra,
The similarities don't exist! Adams didn't mandate that fees/taxes be paid as a condition of citizenship, it was conditional on your employment. If one objected you could quit and go work someplace else. It is much more akin to needing insurance in order to operate a car; don't like it get rid of the car and take the bus. Voila, no mandate. Stupid analogy!!

I would HAPPILY repeal every jot and tittle of the Affordable Care and Patient Protection Act in favor of "Medicare for All."

It would be a vast improvement over what I have now, which I have no hope of improving, which has a 50 year history of erosion and deterioration, and no future prospects except higher costs for less and lower quality service.

--*I would HAPPILY repeal every jot and tittle of the Affordable Care and Patient Protection Act in favor of "Medicare for All."*--

Change the 50 to 45 in your second paragraph and you have an accurate depiction of Medicare's trajectory. The recent DeathCare Act was deemed necessary precisely because of the blooming financial distresses in the government system.

Thomas Paine was a big supporter of welfare and health insurance. In fact, he was such a big supporter of welfare that he spent a good portion of his life being supported by others. It is too bad his big fan, Glen Beck, never bothered to study history in high school (probably too busy boozing like his hero Paine), because if he had, he would realize that in Paine, he is glorifying the socialist that preceded Marx.

You're missing an important point. The 1798 act was entirely concerned with regulating interstate and international commerce, firmly within the constitutional scope of Congress. The, ACA, which can fine you for not having insurance even if you never leave your home state, is a far more expansive interpretation of the power of Congress.

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